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<br /> t � F `RlVIIT APPLICATivN I
<br /> � �_ � ClTY OF EVERETT PERMIT SERVICES �
<br />" ,�x� 3200 CEDAP. STREET, EVERETT, V1�4 98201 ,_�� � "��J/ " ' �-i'
<br /> �"`'' 425-257-8810— FAX 425-257-8857 —www.everethva.org !
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<br /> ;j�j��:� APPLICATIONS ARE ACCEPTED FROM 8 AM TO 4 PM - �EBIT& CREDIT CARDS ARE NOT ACCF.PTED
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<br /> 4 ��i�j SITE ADDF:ESS PARCEL TAX I.D.# PERMIT#
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<br /> �''i'� LEGA LO'I"N0. BLOCK TRACT
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<br /> �� `�,� ' OWNER A�ORESS CITY2IP PHONE � �4
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<br /> . i TENANT NAME �ONTACT FJR PERMIT PHONE 3'; � `
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<br /> � �,}�� CONTRACTOR ( ADDFEoS ,/. / CITY2IP PHONE �
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<br /> CONTR.LICENSE#�2Nr�',�' � �7�J K
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<br /> USE OF BUILDING HEAT SOURC� CONTRACT PRICE OF WORK
<br /> ' �� Electric _Gas Other � "'r" `
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<br /> �, ; WURK DESCRIPTION .�I/; I�/
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<br /> �, PLUMBING MECHANICAL
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<br /> ,,. . NO. TYPE OF FIXTURE OR ITF.M NO. TYPE OF FIXTURE OR ITEM
<br /> -,� _ Z Toilet _ A/C—air handiing units �
<br /> ''';'�. Bathtub Forcedairsystzms
<br /> �y�,.,, �— Lavatory�wash basin) Gas piping
<br /> � Shower 3 Water heater
<br /> Kitchen sink&disposal _ Gas fireplace
<br /> Dishwasher Gas range
<br /> Clolhes washer Clothes dryer
<br /> L2�ndry tray _ Range hood
<br /> ��q / Sink(service/badmop/elc.) Exhaust fan
<br /> , _ Backilow preventer _ Heat pump
<br /> '�``i' Urinal Unit heater
<br /> Drinking Fountain Boiler '
<br /> '�'� � Floor drain Refrigeration �
<br /> '�a,.¢��� _ Grease trap _ Woodstove F''' '
<br /> '�` Roof drains Other
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<br /> Other
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<br /> �i CITY OF EVERE�,7 LOCAL SALE5 SqX CODE IS 3'105
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<br /> �' �:���'� I hereb ceriti ihat I have read and ezamined this a lication and know the same lo be hue 2nd correct. All rovisions of laws and -�b���
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<br /> �? ordinaces goveming this type of work will 6e complie, with whether specified herein or not The granting of a permit does not presume .��
<br />� 'jr� to give authonry to violate or cancel the provision nf any other state or local iaw regulating cor.struction or the performance of I �
<br /> � � , construction.That I am au;horized by the owner of this property to perform the work for which applicatinn is made and I compty with the +
<br /> .;"._ Sta'e Co �r� ors Law 18.27 RCW and 2 �00 WAC. �� ,��
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